Diphtheria tetanus and pertussis vaccine
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Peripheral neuropathy in an infant with a small heat-shock protein 27 gene mutation: case report A 3-month-old male infant with a truncating nonsense mutation in his small heat-shock protein 27 gene developed peripheral neuropathy following administration of the diphtheria tetanus and pertussis vaccine [dosages not stated]. The boy received the diphtheria tetanus and pertussis vaccine and, 1 week later, diffuse weakness was observed. Two months later, he received the booster dose of the vaccine and his weakness worsened. Bilateral foot drop, areflexia and distal atrophy of his legs and arms was revealed by neurological analysis. He had unrecordable motor and sensory nerve conduction velocities with the exception of his left median nerve, which had a motor nerve conduction of 12.5 m/s, a compound muscle action potential amplitude of 0.5mV and a distal latency of 4.6ms. At the age of 9 months, signs of denervation were revealed by needle electromyography. Muscle biopsy findings were consistent with neurogenic atrophy. At the age of 3 years, he developed bronchitis and required artificial ventilation because of right phrenic nerve paralysis. Following this episode, he was unable to walk without support due to severe distal weakness and atrophy. Sural nerve biopsy revealed a decrease in the density of large myelinated fibres. At latest follow-up, he was 8 years old and was wheelchair bound. He had diffusely unrecordable motor and sensory nerve conduction velocities. His father had clinical and electrophysical findings consistent with mild distal motor neuropathy. DNA analysis of the small heatshock protein 27 gene in the father and son revealed a truncating nonsense mutation leading to a premature stop codon. Author comment: "Based on the clinical history of relapses and on the sensory involvement, which rules out a direct effect of tetanus toxoid, our patient could be affected by an inflammatory-relapsing neuropathy triggered by diphtheria-tetanus-pertussis vaccination (incidentally the father was not vaccinated for tetanus, sine the vaccination became mandatory in Italy in 1968)." Mandich P, et al. Severe neuropathy after diphtheria-tetanus-pertussis vaccination in a child carrying a novel frame-shift mutation in the small heat-shock protein 27 gene. Journal of Child Neurology 25: 107-109, No. 1, Jan 2010. Available from: 803021167 URL: http://dx.doi.org/10.1177/0883073809334387 - Italy
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Reactions 26 Jun 2010 No. 1307
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